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Factors Associated With Early Hydroxychloroquine-Induced Retinal Toxicity in Patients With Systemic Lupus Erythematosus
TAKE-HOME MESSAGE
- In this study, the authors investigated the prevalence of, and risk factors for, early hydroxychloroquine retinal toxicity in patients with systemic lupus erythematosus (SLE). Overall, hydroxychloroquine retinal toxicity was found in 11.3% of the patients, with 26.3% of them developing retinal toxicity during the first 5 years of treatment. Patients with early toxicity were more likely to be older (P = .01) and have late-onset SLE. In the logistic regression analysis, lupus anticoagulant positivity (OR, 4.2) and hypercholesterolemia (OR, 5.6) were found to be independent risk factors for the development of hydroxychloroquine retinal toxicity.
- Eye care providers may benefit from knowledge of the factors increasing the risk of hydroxychloroquine-induced retinal toxicity in patients with SLE.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
Hydroxychloroquine is currently recommended for the treatment of systemic lupus erythematosus (SLE), but it can cause irreversible retinal toxicity. This study aimed to identify factors associated with early hydroxychloroquine-induced retinal toxicity in patients with SLE from a single centre for 20 years.
METHODS
SLE patients diagnosed between 1998 and 2017 and followed up for at least 1 year were included. Demographic, clinical, laboratory and therapeutic data were collected from the electronic medical records and retrospectively analysed. Early hydroxychloroquine-induced retinal toxicity was defined as the development of macular toxicity within the first 5 years of hydroxychloroquine treatment.
RESULTS
A total of 345 patients followed for a median of 15 years were analysed; 337 (97.7%) patients received hydroxychloroquine, 38 (11.3%) of them presented with retinal toxicity, and 10 (3%) developed early retinal toxicity. These patients had a mean treatment duration of 3.3 years with a mean cumulative dose of 241 g. Patients were diagnosed by visual field (VF) and fundoscopy, and two were also assessed using spectral domain optical coherence tomography (SD-OCT). The median (IQR) age of patients with early toxicity was 56 (51-66) years, and 80% were female. Factors independently associated with early hydroxychloroquine-induced retinal toxicity were lupus anticoagulant positivity (OR 4.2; 95% CI 1.2-15.5) and hypercholesterolaemia (OR 5.6; 95% CI 1.5-21.5).
CONCLUSION
Our results suggest that lupus anticoagulant positivity and hypercholesterolaemia among SLE patients may be risk factors for early hydroxychloroquine-induced retinal toxicity, regardless of the dose or duration of treatment.
Additional Info
Factors associated with early hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus
Graefes Arch. Clin. Exp. Ophthalmol 2024 Sep 01;262(9)2823-2832, O Araújo, H Hernández-Negrín, RP Casaroli-Marano, J Hernández-Rodríguez, A Adán, G Espinosa, L Pelegrín, R CerveraFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Araújo and co-authors reported the results from a retrospective cohort study that analyzed risk factors related to early hydroxychloroquine (HCQ)–induced retinal toxicity in patients with systemic lupus erythematosus. Given that HCQ-induced retinal toxicity could result in irreversible vision loss, preventively identifying risk factors and making early diagnosis are clinically critical.
The current study did not only confirm traditional HCQ-induced retinal toxicity risk factors, such as HCQ treatment duration and total dosing, but also revealed several early HCQ-induced retinal toxicity risk factors, such as systemic lupus erythematosus anticoagulant positivity and hypercholesterolemia. This is because the current study utilized new diagnostic techniques and international recommendations for the detection of this retinal complication. For instance, the spectral-domain optical coherence tomography test was used; however, not all patients in this cohort were assessed using this test.
Therefore, it is reasonable to suggest that, when revisiting practice guidelines for early HCQ-induced retinal toxicity, both subjective and objective, sensitive and specific tests are recommended.